Medical model

Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained."^[1] This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.

The medical model has proven highly successful and even indispensable in many contexts: it is difficult to name a plausible alternative to medical diagnosis and treatment for a depressed skull fracture.

The medical model embodies basic assumptions about medicine that drive research and theorizing about physical or psychological difficulties on a basis of causation and remediation.

It can be contrasted with other models that make different basic assumptions. Examples include holistic model of the alternative health movement and the social model of the disability rights movement, as well as to biopsychosocial and recovery models of mental disorders. For example, Gregory Bateson's double bind theory of schizophrenia focuses on environmental rather than medical causes. The medical model and these alternative models do not have to be mutually exclusive. A model is not a statement of absolute reality or a belief system, but a tool for helping patients. Thus, utility is the main criterion, and the utility of a model depends on context.^[2]

Other uses

In psychology

Medical model is a term in psychology, indicating the assumption that abnormal behavior is the result of physical problems and should be treated medically. Sometimes this is clearly true, as with traumatic brain injury. But in other cases there has always been doubt about the medical model. In 1927, Sigmund Freud observed, "Psychoanalysis falls under the head of psychology; not of medical psychology in the old sense, nor of psychology of morbid processes, but simply of psychology."^[3]

Among critics of medical psychiatry, Laing observed that because the diagnosis of a mental illness was based on conduct or patient behavior and not on physical pathology, such a "diagnosis" essentially contravened standard medical procedure and hence is not truly within the medical model: physical examination and ancillary tests were conducted, if at all, only after the diagnosis was made. Whereas heart diseases, cancers, and broken bones were diagnosed by evident physical pathology discovered during examination and ancillary tests, a mental illness was diagnosed by examining the patient's behavior rather than physical signs or symptoms.

The germ theory of disease

The rise of modern scientific medicine during the 19th century has a great impact on the development of the medical model. Especially important here was the development of the "germ theory" of disease by European medical researchers such as Louis Pasteur and Robert Koch. During the late 19th and early 20th centuries, the physical causes of a variety of diseases were uncovered, which in turn, led to the development of effective forms of treatment.

The concept of "disease" and "injury"

The concepts of "disease" and "injury" are central to the medical model. In general, "disease" or "injury" refer to some deviation from normal body functioning that has undesirable consequences for the affected individual. An important aspect of the medical model is that it regards signs (objective indicators such as an elevated temperature) and symptoms (subjective feelings of distress expressed by the patient) as indicative of an underlying physical abnormality (pathology) within the individual. According to the medical model, medical treatment, wherever possible, should be directed at the underlying pathology in an attempt to correct the abnormality and cure the disease. In regard to many mental illnesses, for example, the assumption is that the cause of the disorder lies in abnormalities within the affected individual’s brain (specially their brain neurochemistry). This carries the implicit conclusion that disordered behaviors are not learned, but are spontaneously generated by the disordered brain. According to the medical model, for treatment (such as drugs), to be effective, it should be directed as closely as possible at correcting the theorized chemical imbalance in the mentally ill person’s brain.

The importance of diagnosis

Proper diagnosis (that is, the categorization of illness signs and symptoms into meaning disease groupings) is essential to the medical model. Placing the patient’s signs and symptoms into the correct diagnostic category can:

Provide the physician with clinically useful information about the course of the illness over time (its prognosis);
Point to (or at least suggest) a specific underlying cause or causes for the disorder; and
Direct the physician to specific treatment or treatments for the condition.

For example, if a patient presents to his/her primary care provider with symptoms of a given illness, through taking a thorough history, performing assessments (such as auscultation and palpation), and in some cases ordering diagnostic tests the primary care provider can make a reasonable conclusion about the cause of the symptoms. Based on clinical experience and available evidence, the health care professional can identify treatment options which are likely to be successful.

Other important aspects

Finally, adherence to the medical model has a number of other consequences for the patient and society as a whole, both positive and negative. For example:

In the medical model, the physician was traditionally seen as the expert, and patients were expected to comply with his/her advice. The physician assumes an authoritarian position in relation to the patient. Because of the specific expertise of the physician, according to the medical model, this is necessary and to be expected. However, in recent years, the move towards patient-centered care has resulted in greater patient involvement in many cases.
In the medical model, the physician may be viewed as the dominant health care professional, as they are the professionals trained in diagnosis and treatment.
An ill patient should not be held responsible for his/her condition. The patient should not be blamed or stigmatized for his/her illness, whether it be cancer, high blood pressure, the flu, AIDS, depression, or schizophrenia.
Under the medical model, the disease condition of the patient is of major importance. Social, psychological, and other "external" factors, which may influence patient behavior, may be given less attention.

References

↑ Laing, Ronald (1971). The Politics of the Family and Other Essays. Routledge.
↑ http://guilfordjournals.com/doi/abs/10.1521/jsyt.22.2.60.23350?journalCode=jsyt
↑ http://www.academyanalyticarts.org/origins.htm

External links

'Medical model' vs 'social model' British Film Institute Education.
Disability Awareness at the University of Sheffield, UK
Medical model Open university UK

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